ANZCTR search results

Although the lungs in children with cystic fibrosis (CF) are essentially normal at birth, airway infection and inflammation may begin within the first few weeks of life. As postnatal lung development, including significant alveolarisation continues during the first 2-3 years of life, this is a vulnerable period where undiagnosed infection and chronic inflammation may lead to irreversible tissue damage and lung disease. Identifying and treating infection (especially with Pseudomonas), in early childhood may prevent significant lung disease, reduce morbidity and improve survival. Early infection is often subclinical and conventional screening methods such as sputum microbiology, chest radiology and lung function, are either not possible or insensitive to detect disease in this age group. Upper airway cultures such as throat swabs or cough suction specimens correlate poorly with lower airway pathogens and the currently available systemic markers of inflammation lack sensitivity. Bronchoaclveolar lavage (BAL) is considered the gold standard for identifying airway infection and inflammation in young children with CF. The association between BAL markers of infection and inflammation and sensitive infant lung function testing such as the multiple breath washout test which determines the lung clearance index has not been studied. This study will investigate early CF lung disease by assessing the relationships between BAL markers of infection/inflammation, the lung clearance index, systemic markers of neutrophil inflammation (S100 proteins) and urinary desmosine. The study will also determine the prevalence of gastro-oesophageal reflux and the relationship between BAL pepsin and airway infection and inflammation.

Recently some neonatal intensive care units have adopted the side lying position for bottle feeding preterm babies. It is thought that there may be a benefit in preterm babies’ bottle feeding in this way. The usual method to give a bottle feed is with a cradle hold. We think that the side lying position more closely resembles the position babies adopt for breastfeeding. Some clinicians have observed that some preterm babies appear to feed better in the side lying position as they seem to be better able to regulate the flow of milk and have been shown to have a more stable heart rate and to be able to breathe better in this feeding position. There is a small amount of evidence to show that the side lying position may have some benefits when bottle feeding preterm infants. However, there are no good studies comparing the effect of the two bottle feeding positions, side lying versus the cradle hold. The aim of this study is to investigate the two bottle feeding positions in a small group of preterm infants. We want to find out if one position is better than the other in terms of a baby’s breathing and heart rate during the feed.

Patients referred to the community rehabilitation programs (CRPs) at the Peter James Centre (PJC) and Wantirna Health (WH) have traditionally been placed on a waiting list and given a triage category, which guides clinicians as to who should be seen first when demand exceeds supply. This study is trialling an alternative model of triage within the orthopaedic team at the PJC CRP in which all patients are seen for a face to face assessment soon after referral, with a subsequent decision on priority and patient management made by the treating clinician. The aim of the trial is to compare the outcomes with the traditional model at WH, and determine whether the new model improves waiting times without negatively impacting on the quality of service received, patient outcomes or staff and patient satisfaction

This study will be a randomised controlled trial to evaluate the clinical benefits of two feeding intervention programs for children with a history of fussy eating, but no major medical history. Baseline assessment will include parent completed questionnaires and on-site feeding and growth assessments. There are two arms of intervention. Arm One is an individual operant conditioning arm. Arm Two involves small group systematic desensitisation therapy. Both arms will involve group parent education sessions regarding nutrition, behaviour management and feeding development. Intervention will be provided in either an intensive format (10 times over the course of a week) or in a weekly format (10 times over 10 weeks) at the discretion of the parent.

This study has been designed to investigate how a high-protein or high-fat preload effect thermogenesis, antropyloroduodenal motility, gut hormones, gastric emptying and appetie. Volunteers are required to visit the department on 3 occasions (6 if they wish to take part in Study 2 as well) approximately 7 days apart. They will be required to injest one of the three preloads on each occassions, and lie supine under a calorimetry hood. Venous blood samples will be taken at set intervals and appetite questionnaire will be answered after a blood sample has been collected. A buffet meal will be presented at 180min and consumed over 30 minutes until comfortably full.

A randomized, placebo-controlled, double-blind, parallel study designed to evaluate the effect of intra-articular knee injection of Ampion (Trademark) in male or female subjects 40 years to 85 years old (inclusive) with symptomatic primary knee osteoarthritis for 6 months preceding screening. The study consists of a 3 week screening period and a 4 day study participation period. Each subject will be randomized to receive a single 10 mL knee injection of one of the following: 1. Ampion(TM) combined with lignocaine/betamethasone suspension 2. Ampion(TM) combined with betamethasone suspension 3. Saline placebo combined with lignocaine/betamethasone suspension

This trial will examine the effect of a new solution on the ocular surface, subjective ocular comfort and anti-microbial efficacy of the new solution by lens case contamination. The hypotheses are these outcomes will be similar for each lens type and similar for published data on other solutions

Our study aims to fill a knowledge gap about a highly relevant question for emergency medicine that has not had any solid research behind it. We aim to prove or disprove if there is any evidence in giving intravenous 0.9 NaCl to the length of stay and symptoms of patients presenting to the emergency department with alcohol intoxication. We will also consider the economic costs of providing intravenous saline and associated ED stay for these patients compared to observation alone.

In cases where patients have inoperable tumours, direct destruction of focal tumours using various energy sources such as heat (radiofrequency ablation, microwaves), cold (cryotherapy) or ethanol injection have been used for the last twenty years. A needle is placed into the tumour under image guidance in a similar way to taking a biopsy. The energy used, heat or cold, destroys the tumour. Currently not all inoperable tumours can be treated in this way because tumours may lie close to vital structures that may be affected and therefore pose a large risk to patients. The new technology, irreversible electroporation, does not use heat or cold and therefore spares vital structures. Direct electrical current is used to destroy the outer membrane of the tumour cells. We are testing the safety and effectiveness of this form of ablation.

There is a severe shortage of geriatricians and gerontic nurses across Australia. These specialists play a pivotal role in hospital geriatric consultation services which, among other clinical functions, make important triage decisions around access to geriatric assessment units, rehabilitation, community post-acute care, and residential care. In the face of inexorable workload growth, improving the efficiency of geriatric consultation without compromising integrity of the process, is a major challenge. This study explores the reliability, safety and cost-effectiveness of an “online” method of conducting geriatric assessment. The model under scrutiny has been developed by the Academic Unit in Geriatric Medicine and the Centre for Online Health at the University of Queensland. It comprises: - Standardised assessment (based on the interRAI Acute Care system) performed on location by a specifically trained gerontic nurse - Data entry on web-based software - An inbuilt clinical decision support system - A capacity for geriatricians to review and report cases “online” (who can be anywhere in the world) immediately on completion of the nurse assessment - A training strategy for all participating and affiliated practitioners - Electronic messaging systems to facilitate distribution of findings among clinicians. Preliminary research suggests the method to be attractive to clinicians, reliable, safe and highly efficient, while improving the quality of assessment and promoting the skills of gerontic nurse assessors. The study will examine: - The level of agreement between online and live geriatrician clinical assessments and recommendations, taking into account inter-rater reliability of live consultations. The cost of the “online” approach compared to conventional geriatric consultation (including a formal economic evaluation) Paired assessments (online and live) of 115 patients referred for geriatric consultation will be performed by separate geriatricians. To evaluate “natural” variation between geriatrician assessment, inter-rater reliability of (115 paired) live assessments will also be determined. Three pairs of geriatricians across 3 hospital sites will participate. The paired assessments will be randomly configured to remove potential biases. Combinations relate to format (live-live or live-online) and order of patient contact (the order of geriatrician consultation will be randomly allocated for live-live pairings). The assessment outcomes of interest include recommendations for rehabilitation and permanent long term care, as well as diagnoses of common geriatric syndromes. Agreement will be characterised by kappa statistics calculated to appraise the level of agreement of triage recommendations. New diagnoses not present in the medical record at the time of assessment will be recorded, to identify the risk and potential impact of these being overlooked in the online approach. Each procedure will be subject to a detailed costing analysis to support an economic evaluation. If demonstrated to be valid, safe and cost effective, the online assessment method may generate considerable cost savings and dramatically extend the availability of high quality specialist comprehensive geriatric assessment across Australia and the world.